Scottish Health Council 12 October 2011 Care about Rights Project Evaluation

The Scottish Human Rights Commission Created by Scottish Parliament to promote and protect all human rights – civil, political, economic, social and cultural Independent of Government and Parliament Promotion: –- Education and awareness raising –- Research –- Information and events Protection powers to: –- Undertake inquiries; –- Recommend changes to law; –- Intervene in court cases; –- Enter places of detention

A Human Rights Based Approach PANEL: –Participation –Accountability –Non-discrimination –Empowerment –Legality

A Human Rights Based Approach- Principles in Practice Empowerment – supporting people to know and claim their rights Ability – supporting public authorities & others to adopt a human rights based approach Accountability – increasing accountability for respecting, protecting and fulfilling human rights

Programme of work covering adult protection, human rights in healthcare and older people’s rights in social care. Concerns from variety of sources about issues such as: Restraint CCTV and other “assistive technologies” Door locking Social isolation and mental health issues Inadequate provision personal care Covert and/or inappropriate medication Malnutrition Dementia care Elder abuse Dignity in Care

Care about Rights? Older People & social care project Resource pack of films, case studies and information Older people and their carers, providers of care services, policy makers and the regulator Distribution to every registered service for older people's care in Scotland and online at eaboutrights Extensive training for care providers Awareness raising with Regulator Partnership and capacity building with outreach groups across Scotland

Moving from know-what to know-how European Convention on Human Rights (and Human Rights Act): Article 2 (right to life); Article 3 (freedom from torture and ill-treatment); Article 5 (liberty); Article 6 (fair trial); Article 8 (right to protection of the home, private and family life- including autonomy in decision making and the right to live with dignity); Article 14 (non-discrimination) Other international human rights standards: International Covenant on Economic, Social and Cultural Rights (right to adequate food, right to the highest attainable standard of physical and mental health etc) International Covenant on Civil and Political Rights (right to dignified conditions of detention, freedom of movement etc) Convention on the Rights of Persons with Disabilities (Participation, human dignity and non-discrimination, Right to physical integrity, to participate in decision making, to live independently and be included in the community, personal mobility etc)

FAIR model Facts: What is the experience of the individual? Are they being heard? What are the important facts to understand? Analysis of rights at stake: What are the human rights at stake? Can the rights be restricted? What is justification for restricting the right? Is the restriction proportionate? Identify shared responsibilities: What changes are necessary? Who has responsibilities for making changes? Review actions: Have the actions taken been appropriately recorded and reviewed and has the individual been involved?

Why a HRBA worked for care providers Improving service delivery Balancing risk and quality of life considerations Person- centred care Better communication– a common framework of rights and responsibilities Foundation for other duties Not a risk or a burden but a tool for improving care. Poor service provision Risk averse and rights limiting Policy driven not person centred Conflicted relationships and misunderstandings Legal and regulatory challenge No service innovation or improvement Getting it Right v Getting it Wrong

Evaluation of Care About Rights Independent Evaluation on project by the social and economic research organisation, Ekosgen, Phase 2 Evaluation Report “staff are working in an industry that is rife with people who all feel they are acting in the best interest of the resident – doctors, social workers, regulators and families. Care about Rights provides a framework for staff to speak up for older people … and has given staff the confidence and ability to get their point across”. – care manager “It [Care About Rights] is giving me practical skills to actually use in my advocacy work. It’s helped to make legislation like that real.” – advocacy worker “…It [Care About Rights] is aligned with and adds value to professional and occupational standards – it is not new! Human rights are built into the care standards and Care About Rights is a tool to bring this to forefront in a delivery setting…” – care manager

Evaluation of Care About Rights

Results of end line survey of care worker training participants (82 respondents to end line survey/ 799 baseline responses) showed: 99% understood what human rights are and how they are applicable to their work. 90% agreed or strongly agreed that they could communicate with colleagues about how human rights could improve the delivery of care. 94% understood the relationship between human rights and other legislation 97% of respondents to the follow up survey feel that a human rights based approach can help care providers develop positive relationships with service users and their families.

Conclusions: Phase 2  Conclusions:  Well aligned policy priorities and values  Resources, well received  Support from stakeholders, providers and older people  Success in engaging ‘correct’ staff  Variation in the way training has been rolled out  Evidence of success in delivering against aims and outcomes  Significant benefit - clear framework for assessing situations, identifying issues and considering solutions  Conclusions:  Well aligned policy priorities and values  Resources, well received  Support from stakeholders, providers and older people  Success in engaging ‘correct’ staff  Variation in the way training has been rolled out  Evidence of success in delivering against aims and outcomes  Significant benefit - clear framework for assessing situations, identifying issues and considering solutions Evaluation of Care About Rights

Connected Work: Older People Charter of Rights for persons with dementia, their families and carers Joint Improvement Team Guidance on Social Care Commissioning and Procurement. Joint Statement with Electoral Commission and Care Commission on supporting residents living in care facilities to vote Joint Statement with Mental Welfare Commission and Care Inspectorate on use of CCTV in care facilities. Southern Cross statement on human rights responsibilities of government and local authorities regarding services in transition Engagement on care policy issues- e.g. self directed support, regulation of care, Christie Commission vision on the future of public services. UN Open Ended Working Group on Ageing - a new international treaty?

Health and Human Rights Evaluating a human rights based approach at The State Hospital, Carstairs Raising awareness of health & human rights with NHS Boards, MEHRB Healthcare Quality Strategy Patients Rights Act & Charter Health Inequality and Human Rights Impact Assessment (HIIA) with NHS Scotland and SG Health Directorate Developing integrated human rights and equality impact assessments project 2011/12

A Human Rights Based Approach to health and social care Towards a HRBA of –Empowerment (e.g. Charter of Rights, Patients Rights Charter of Rights & Responsibilities, Care about Rights); –Accountability (e.g. Regulation, Complaints, Legal challenge); & –Ability (e.g. Knowledge and resources- Care about Rights, Health Care Quality Strategy, Commissioning practices etc) New era of service re-design and integration in face of demographic change and financial constraint. Human Rights providing assurances and not assumptions about public services. Human Rights as a value base for setting priorities in health and social care policy and practice as well as delivery of services.

Kavita Chetty Legal Officer- Human Rights Based Approach